Form Sf-1040x-Amended Individual Tax Return Page 2
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1
2Part I
Exemptions
Complete only if a change in exemptions
A Number
B Net Change
C Corrected number
originally
reported
1 Exemptions - yourself and spouse
2 Your dependent children who lived with you
3 Other dependents
4 Total exemptions (add lines 1 thru 3)
5 Multiply the total number of exemptions claimed by
$750.00 (for 1999 thru 2008 use $1,500.00 and
$600.00 for 1998 and prior years)
6 Enter first names of your dependent children who lived
Enter
with you, but were not claimed on original return:
number
Enter
7 Other dependents not claimed on original return:
number
Name
Relationship
Number of months
Did dependent have
Did you provide more that one-
lived in your home
income of $750.00 or
half of dependent's support?
more?
Son
Yes
Yes
Son
Yes
Yes
Part II Explanation of changes to income, deductions, and credits
Enter the line reference from pg 1 for which you are reporting a change and give the reason for each change.
Attach applicable schedules.
Instructions for filing the amended return
Lines 1 thru 11 in column A should appear the same as they were last (as originally filed, as corrected by Springfield or as last
amended). Column B should contain only the amount to be added or subtracted from that particular line. Column C should
contain the correct amount.
All amounts appearing in column B must be explained on pg 2, part II and must have all supporting documentation attached for
verification, this includes but is not limited to the following: A copy of the Federal 1040X, IRS letter of adjustment, additional and
or corrected schedules, forms, worksheets, etc.
If you need assistance in preparing your Springfield return, you may come into our office or call 269-965-8324. Office hours are
7:00 am to 6:00 pm, Monday thru Thursday. City Hall is closed on Fridays.
Sign Here
Taxpayer's signature
Date
Signature of preparer other than taxpayer
Date
Sign Here
Spouse's signature
Date
Address and phone number
Mail completed return to: City of Springfield, Income Tax Department, 601 Avenue A, Springfield, MI 49037-7774
(Make checks payable to: City of Springfield)
(Make checks payable to: City of Springfield)
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